patho ch34.txt

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  1. describe acute renal failure in terms of cause treatment and outcome
    • acute renal failure is rapid decline in kidney function
    • can be prerenal,intrarenal,postrenal
    • 80-95% pre or intrinsic
    • if treated early, kidney function may be restored
  2. differentiate prerenal failure in development and manifestation
    prerenal decreases perfusion of kidneys, most common, hypovolumia,afferent vasoconstriction, blood flow down below 25% ishemia, elevated BUN to creatinine
  3. differentiate intrinsic failure in development and manifestation
    • results from damage to kidney structures,
    • ATN - tubular epithelial, from sepsis or hypovolumia
    • from toxic insult, tubular obstruction or ischemia
  4. differentiate postrenal failure in development and manifestation
    • results from obstruction of urine outflow,
    • ureter, bladder, or urethra (prostatic hyperplasia)
    • usually must be bilateral to cause failure
  5. cite two main causes of ATN and describe the three phases
    • destruction of tubular epithelial cells,
    • caused by toxic,ischemia,sepsis,obstruction or infection
    • onset or initiation - time of event to tubular injury
    • maintenance - decreased GFR, retention,edema,oliguria
    • recovery - repair of renal tissue,increase in urine output,
  6. most common cause of chronic kidney disease
    hypertension then diabetes
  7. describe the five stages of chronic kidney disease
    • CKD is kidney damage or GFR<60 for 3 months or longer
    • 1-kidney damage GFR>=90
    • 2 - kidney damage GFR 60-89
    • 3 - GFR 30-59
    • 4 - GFR 15-29
    • 5 - FAILURE GFR < 15 or dialysis
  8. describe the methods used for an accurate GFR and rationale for its use
    • normal GFR 120-130
    • serum creatinine or 24 urine creatinine
    • increase in Albuminuria
  9. what causes fluid and electrolyte imbalance in CKD?
    • inability to concentrate urine,
    • inability to regulate sodium,
    • hyperkalemia develops late
    • acidosis due to decreased H+ excretion and bicarb reabsorbtion
  10. what causes disorders of skeletal and hematological in CKD?
    • abnormal Ca and Ph occur early
    • serum Ph rises due to lack of excretion thus,
    • Ca levels fall, PTH rises, demineralization, reduced activation of Vitamin D
    • anemia due to decreased EPO, blood loss, low iron, and blood urea
  11. what causes cardiovascular and immune disorders in CKD?
    • hypertension due to increased fluid, renin-angiotensin, possible uremic pericarditis
    • immune and inflamation can be limited by blood urea
  12. what causes neurologic, skin, and sexual dysfunction in CKD?
    • uremia can demylenate cause neuropathy
    • uremia can affect CNS
    • skin can be pale due to anemia,dry skin,itching
    • sexual from neural,hormonal,and drugs used to treat
  13. state the basis for adverse drug reactions in patients with CKD
    • many drugs and metabolites are elimnated by the kidney,
    • decreased albumin means more drug is free to act
  14. what are the principles of dialysis and difference between hemodialysis and peritoneal dialysis
    • blood delivery system
    • dialyzer - artificial tubular filter takes blood cells and proteins, substances can be added
    • dialysis fluid delivery system, to arteriovenous shunt
    • peritonal dialysis - dialyzing solution added to the peritoneal cavity, dwells for osmosis then is drained
  15. possible complications of kidney transplant?
    histocompatibilty, adequate organ preservation, and immune management. immunosupressants given,
  16. goals for dietary management in persons with CKD?
    • restriction of dietary proteins descreases breakdown to BUN and acids
    • limitation of sodium and fluid
    • limit phosphorus intake
  17. causes of CKD in children and special problems
    • children < 5yo - congenintal malformation
    • children > 5yo - aquired and inherited disorders
    • special problems with growth and development
  18. why is CKD more common in elderly, what can prevent this?
    • normal aging decreases GFR
    • secondary disease causes of CKD more common
    • secondary diseases can be treated and nephrotoxic drugs can be avoided
  19. treatment of CKD in children and elderly
    • children - transplant,dialysis,
    • elderly - different monitoring standards due to decreased muscle mass, individualized hemodialysis, decreased transplants with age
  20. what is the difference between acute and chronic kidney failure/disease
    • acute-abrupt in onset, often reversible if recognized early and treated appropriately
    • chronic-end result of irreparable damage to kidneys, develops slowly
  21. What is the difference between prerenal, intrinsic and postrenal causes of kidney failure?
    • prerenal - decreased renal perfusion
    • intrinsic-damage to structures within kidney
    • postrenal-obstruction of urine outflow from kidney
  22. congestive heart failure what be a _______ cause of renal failure?
  23. common causes of CKD
    • hypertension
    • diabetes mellitus
    • polycystic kidney disease
    • obstructions of urinary tract
    • glomerulonephritis-autoimmune,strep,empitigo
    • cancers-renal cell, urolithial
    • autoimmune disorders - ESL
    • Disease of heart or lungs - CHF
    • chronic use of pain medication
  24. treatment during renal insufficiency phase of renal failure
    • prompt treatment of UTI - prevent pyelonephritis
    • avoid nephrotoxic medication
    • control blood pressure
    • control blood sugar in diabetes
    • stop smoking
  25. how does high blood pressure make CKD worse?
    thickens basement membrane, kidney becomes less compliant
  26. Clinical manifestations of CKD
    • accumulation of nitrogenous wastes
    • alterations in fluid electrolyte balance
    • mineral and skeletal disorder
    • anemia and coagulation disorder
    • GI disorders
    • hypertension and cardiovascular disorder
    • neurologic complications
    • disorders of skin integrity
    • immunologic disorder
Card Set:
patho ch34.txt
2011-10-31 18:37:25

Mountain State University Physician Assistant class of 2014
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